|credit: Huffington post.com|
In those states that will offer the customer several choices, rate increases as high as 35% are being mentioned. That will be coupled with fewer doctors or specialists in network, a limited choice of hospitals or clinics, and fewer drugs in the lowest tiers of coverage. The Affordable Care Act's flaws are starting to cause serious problems. They are fixable, but at the moment our political climate is more interested in fixing blame.
If you are 65 or older, this drumbeat of bad news doesn't affect you directly. Medicare will have little, if any, premium changes. Rate increases for Medigap, Part D drug coverage, or Medicare Advantage programs are likely to be much more reasonable because of intense competition.
However, pre-retirees, or younger spouses will find themselves trapped in a system that is rapidly reaching unsustainability.The health care system in the United States is unlike any other developed country. We have a for-profit approach to health care. While that provides for the best medical care possible, it has the very real potential for financial hardships or even ruin if someone isn't prepared or can't find coverage.
Recent studies tell us that at least $250,000 in lifetime costs are very possible for those over 65. Don't we assume that with Medicare, a Medigap policy, or an Advantage option, and drug coverage that can't possibly be right?
Unfortunately, the most expensive parts of our health costs aren't covered by those items. Moving into an assisted living facility can easily cost $3-$4,000 a month (or more). A nursing home might be closer to $5,000 a month. Medicare pays nothing, or for only a limited period of time.
If you elect to stay in your home you will still need expensive on-site nursing and custodial care that can cost about the same as being in a facility. Research shows 70% of us will need either short and long term care at some point.
Traditional Medicare doesn't pay for hearing aids, dental care, or eyeglasses (except after cataract surgery). It has limits on durable equipment. Except for a few exceptions it does not cover alternative care. Even with Part D coverage, prescription drugs are not going to get cheaper. Medicare is prohibited by law from negotiating lower drug prices. Congress has decided that Big Pharma must be protected, even with profits approaching $100 billion a year.
Lots of folks insist that health insurance is better and cheaper when left to private companies. Having been in the individual health market for over 30 years, I beg to differ. Rates always went up, sometimes by a little, sometimes by a lot, but always up. Coverage went down, drug costs showed massive increases, and deductible got higher. Since I became Medicare-eligible my direct costs have fallen by over 50%.
Of course, with some new drugs costing up to $10,000 a month (!), I still face very high costs if I am unlucky enough to get a serious disease that requires such expensive treatment.
What I will never understand is the protest against single-payer insurance until someone signs up for Medicare. Then, the complaints cease and the praise begins. Medicare is a single-payer system that works well for the consumer. Is there fraud? Sure. Do doctors make less? Yes. Does it need to make itself financially healthy? Of course. But, looking at the private system those under 65 must live (or die) with, I am hard pressed to see how the price gouging, lack of competition, and poor service is better. And, all of that started well before the Affordable Care Act.
Next year is going to bring back-breaking cost increases to millions of our fellow citizens. It is also going to bring us a new president and many new members of Congress. Whether that means any fundamental changes is anyone's guess.